Explore the vast range of titles available.

In this discussion paper, we describe the history of the science and societal action resulting in the mitigation of neurotoxic disorders from exposure to organic solvents at the workplaces in Sweden. When alkyd paints were introduced in large scale in construction painting in the 1960s and 1970s, Scandinavian unions voiced increasing concern as members reported symptoms like headache and vertigo, supported by participatory studies and case studies. Although acute and chronic neurotoxic effects were established for some specific solvents such as carbon disulphide, this was not the case for those used in the new paints. Union advocacy promoted formal epidemiological studies, providing increasing evidence for chronic neurotoxicity at levels far below current occupational exposure levels. The results were widely disseminated and accepted and led to concerted action with preventive measures, most importantly substitution of the organic solvents in paints for indoor use, but also drastic reductions in occupational exposure limits. The findings also resulted in funding of further research on solvent toxicity and the establishment of expert groups to advice authorities on occupational standards for exposure to chemicals. The substitution strategy was subsequently adopted in many other countries and occupational exposure limits were lowered, although several years or even decades later. While the societal context in Sweden was unique in many ways, we conclude that there are lessons to be learned from this preventive success when addressing current challenges.

Many studies suggest that increased exposure to urban greenness is associated with better population health. Accessing nature can in some circumstances, however, be difficult, especially for individuals with mobility constraints. Therefore, a growing body of work is investigating the ways to replace the in vivo experience with forms of \"virtual\" contact, in order to provide these individuals with at least some benefits of the natural environment. The aim of this paper is to provide a review of previous use of virtual reality (VR) nature in health and care settings and contemplate the potential use of this technology in future. Our central question is whether engaging with virtual nature can contribute to enhanced physical and emotional well-being in housebound or mobility-constrained individuals. We conclude that while contact with real-world nature is preferred, VR use can be an alternative in cases when in vivo contact with nature is not possible. There are many possibilities for the use of VR technology in psychiatric and medical care; however, the risks, benefits, and cost efficiency of these attempts should be carefully assessed and the outcomes should be measured in a scientifically valid manner. The current review has nonetheless demonstrated that VR nature could play a role in each of the proposed mediating mechanisms linking natural environments and health.

Stunting among children under five years of age is a global public health concern, especially in low-and middle-income settings. Emerging evidence suggests a gradual reduction in the overall prevalence of stunting in Rwanda, necessitating a qualitative understanding of the contributing drivers to help develop targeted and effective strategies. This qualitative study explored the lived experiences of women and men to identify key issues that influence childhood nutrition and stunting as well as possible solutions to address the problem. Ten (10) focus group discussions (FGDs) were conducted with fathers and mothers of children under five years of age from five districts, supplemented by forty (40) in-depth interviews (IDIs) with Nurses and Community Health Workers (CHWs). Transcripts were coded inductively and analysed thematically using Dedoose (version 9.0.86). Three themes emerged: (1) Awareness of a healthy diet for pregnant women, infants, and children with subthemes Knowledge about maternal and child nutrition and feeding practices; (2) Personal and food hygiene is crucial while handling, preparing, and eating food with subthemes, food preparation practices and the feeding environment (3) factors influencing healthy eating among pregnant women, infants, and children with subthemes; Barriers and facilitators to healthy eating among pregnant women and children. Several factors influence child stunting, and strategies to address them should recognise the cultural and social contexts of the problem. Prioritisation of nutrition-based strategies is vital and should be done using a multifaceted approach, incorporating economic opportunities and health education, especially among women, and allowing CHWs to counsel households with conflicts.

In an editorial in an earlier issue of this journal, Johanson & Tinnerberg (1) expressed serious and well-founded concern over the large number of future occupational cancer cases that will result if exposures for a number of substances are not reduced below the so-called \"binding occupational exposure limit values\" (BOELV) issued by the EU (2). The balance between what is perceived as possible to comply with and the foreseeable health gain when setting BOELV is further discussed in a letter to the Editor by Cherrie (3). This debate raises several important aspects of how to protect workers from cancer as well as other potentially lethal diseases. Herewith, we discuss some of these aspects. One problem in setting OEL is that levels that are considered safe may not be seen as feasible when accounting for technological and societal aspects. The EU has recognized this problem by distinguishing between so-called \"indicative\" (health-based) and legally binding OEL (4). However, a BOELV that does not protect from a high risk for severe health effects is not adequate. Both Johanson & Tinnerberg and Cherrie point to respirable crystalline silica (RCS) as an example: While the EU’s Scientific Committee on Occupational Exposure Limits (SCOEL) recommended an OEL <0.05 (5) in order to protect workers reasonably well against negative health effects, the EU decided on a BOELV of 0.1 mg/m³ for RCS (2). The US Occupational Health and Safety administration (OSHA) has come to a different conclusion and decided on an OEL of 0.05 mg/m³ (6). The EU has presented an extensive risk assessment for RCS developed within the SHEcan project (7). We argue that a BOELV at 0.1 is insufficient and partly may be due to misinterpretations of the SHEcan report. The report estimates the future number of lung cancer cases attributable to occupational exposure to RCS in the EU up to 2069. Four scenarios are discussed: (i) a baseline scenario, essentially predicting future numbers of cases without further regulatory action, (ii) a BOELV of 0.2 mg/m3 with 99% compliance, (iii) a BOELV of 0.1 mg/m³ with 99% compliance, and (iv) a BOELV of 0.05 mg/m³ with 99% compliance. The estimations are based on an assumption of a latency period of 10–50 years from reduction of exposure until cancer risk drops. This assumption, in itself reasonable from present evidence, has the consequence that there is virtually no difference in projected annual future cases between the four scenarios for ≥40 years. The reduction in exposure in scenarios ii–iv comes into effect first only in the year 2050 (see figure 4.1 on p49 in ec.europa.eu/social/BlobServlet?docId=10161&langId=en). An assumption of 99% compliance with the BOELV in scenarios ii–iv has a dramatically stronger effect on the projected number of cases than the OEL itself: Even if the OEL was doubled to 0.2 mg/m³ the number of attributable cancer registrations in 2060 would be reduced by 70% just from the assumption of almost full compliance. The additional number of attributable cancer registrations that are prevented when an OEL of 0.1 (scenario iii) is compared to an OEL of 0.05 (scenario iv) under an assumption of almost full compliance is comparatively small (7, p123). The reason for this strong effect of a 99% compliance is that exposure often will exceed the OEL. The report may lead to the misconception that an OEL of 0.05 mg/m³ has little benefit over an OEL of 0.1 mg/m³, especially if the cases saved are expressed as lives saved per year over the entire 60-year period. For Sweden and other countries where OEL already have legal status, the introduction of BOELV would have no legal implications. The SHEcan report shows that occupational exposure to silica will cause in all 440 000 cancer cases between 2010 and 2069 in the EU if nothing further is done (scenario i). This number must be reduced even if it will take time until preventive measures have full effect. An analogy with asbestos is obvious: it is well known that reductions in the mesothelioma rate were seen first only many decades after asbestos was banned – yet no one would argue that it was not worth reducing asbestos exposure for this reason. The report assumes an annual 7% decrease in silica exposure levels until the period 2020–2029 even if no further regulatory action is taken. This is a very questionable assumption that went unconfirmed in a recent French report (8) that gave no evidence for reduced exposure to RCS in the French construction sector during the last decade. This indicates that even the very high number of 440 000 attributable cancer registrations is underestimated by the report, to which, in addition, should be added the number of chronic obstructive pulmonary disease and kidney disease cases, for which a much shorter latency period until risk drops is likely. The concepts “maximum tolerable risk” and “acceptable risk” have been developed for exposure to genotoxic carcinogens, for which no exposure level could be considered safe. A life-time extra number of four cases per 1000 exposed workers over a 40-year working life has been suggested as a maximum tolerable risk, and four cases per 100 000 exposed workers as an acceptable risk, both in Germany and in the Netherlands (9, 10). These figures can be transformed to the individual life-time risk of contracting cancer from the exposure as 4/1000, corresponding to 0.4% individual risk. While these limits are not absolute and can be discussed, it is of interest to apply them to the case of RCS. The risk associated with an OEL of 0.1 mg/m³ for RCS is associated with risks far higher than “maximum tolerable”, ie, 0,4%. The US OSHA estimated that exposing 1000 workers for 45 years at 0.1 mg/m3 would result in 33 extra lung cancer deaths as life-time risk, corresponding to an individual risk of 3.3% (6), exceeding the maximum tolerable risk nearly 10-fold. Since the EU Directive concerns cancer, the report did not consider other health effects, which is necessary for a general risk assessment. The US OSHA estimated there would be another 85 deaths from non-malignant lung disease (8.5%) and, roughly estimated, 39 deaths from renal disease (3.9%) that should be added to this toll. This adds up to an individual excess death risk of 15%, which by far clearly exceeds what is generally seen as the maximum tolerable risk of 0.4%! Still, this is a conservative estimate, which includes neither excess deaths from myocardial infarction that occur from 0.025 mg/m³ and up (11) nor excess autoimmune disease, eg, rheumatoid arthritis and other autoimmune diseases (12, 13). In support of Johanson & Tinnerberg (1), we argue that the lifetime excess death risk for silica-exposed workers is totally incompatible with fundamental workers’ rights of health and safety. This aspect, which must be safeguarded by the OSH society, will be even more important when working life is prolonged and when exposure conditions may be more diverse, ie, workers with high exposure and excessive risk may be too few to impact the disease burden in society but in that group the burden may still be extreme. In our view, the assumption of 99% compliance is unrealistic and it is necessary to lower the OEL. In addition, leaving the BOELV at 0.1 mg/m3 means this will continue for the future, a silent epidemic that is deeply unethical to ignore. References 1. Johanson G, Tinnerberg H. Binding occupational exposure limits for carcinogens in the EU - good or bad? Scand J Work Environ Health 2019 May;45(3):213–4. https://doi.org/10.5271/sjweh.3825. 2. Directive EU. (EU) 2019/130 of the European parliament and of the council of 16 January 2019. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32019L0130. 3. Cherrie JW. Binding occupational exposure limits for carcinogens in the EU - necessary but not sufficient to reduce risk. Scand J Work Environ Health 2019 Jul;45(4):423–4. https://doi.org/10.5271/sjweh.3836. 4. SCOEL. SCOEL’s involvement in setting Occupational Exposure Limits: Webpage accessed 2019-10-23. Available from: http://ec.europa.eu/social/BlobServlet?docId=3879&langId=en. 5. SCOEL. Recommendation from the Scientific Committee on Occupational Exposure Limits for Silica, Crystalline (respirable dust). SCOEL/SUM/94. November 2003. Available from: http://ec.europa.eu/social/BlobServlet?docId=3803&langId=en. 6. OSHA. Occupational Exposure to Respriable Crystalline Silica. Federal Register/vol 81, no 58/Friday, March 25, 2016/ Rules and Regulations. Occupational Safety and Health, Department of Labour, Administration (Docket No. OSHA-2010-0034) RIN 1218/AB70. OSHA 2016. Available from: https://www.govinfo.gov/content/pkg/FR-2016-03-25/pdf/2016-04800.pdf. 7. Cherrie JW, Gorman Ng M, Searl A, Shafrir A, van Tongeren M et al. Health, socio-economic and environmental aspects of possible amendments to the EU Directive on the protection of workers from the risks related to exposure to carcinogens and mutagens at work. Respirable crystalline silica. IOM Research Project: P937/8, May 2011. Available from: https://ec.europa.eu/social/BlobServlet?docId=10161&langId=en). 8. ANSES. Agence nationale de sécurité sanitaire alimentation, environnement, et du travail (ANSES). Dangers, expositions et risques relatifs à la silice cristalline. Avis de l’Anses Raports d’expertise collective (Saisine no 2015-SA-0236). Avril 2019. Èdition scientifique. ANSES English summary: Available from: https://www.anses.fr/en/content/exposure-crystalline-silica-poses-high-risks-worker-health 9. Federal Institute for Occupational safety and Health. The risk-based concept for carcinogenic substances developed by the Committee for Hazardous Substances. Federal Institute for Occupational safety and Health (BAuA), Dortmund, Germany, 2013. Available from: www.baua.de/dok/3581564 10. Health Council of the Netherlands. Guidelines for the calculation of occupational cancer risk values. Health Council of the Netherlands, 2012. Available from: www

OBJECTIVE: This study aimed to investigate whether workplace factors and occupations are associated with SARS-CoV-2 infection or severe COVID-19 in the later waves of the pandemic. METHODS: We studied 552 562 cases with a positive test for SARS-CoV-2 in the Swedish registry of communicable diseases, and 5985 cases with severe COVID-19 based on hospital admissions from October 2020 to December 2021. Four population controls were assigned the index dates of their corresponding cases. We linked job histories to job-exposure matrices to assess the odds for different transmission dimensions and different occupations. We used adjusted conditional logistic analyses to estimate odds ratios (OR) for severe COVID-19 and SARS-CoV-2 with 95% confidence intervals (CI). RESULTS: The highest OR for severe COVID-19 were for: regular contact with infected patients, (OR 1.37, 95% CI 1.23–1.54), close physical proximity (OR 1.47, 95% CI 1.34–1.61), and high exposure to diseases or infections (OR 1.72, 95% CI 1.52–1.96). Mostly working outside had lower OR (OR 0.77, 95% CI 0.57–1.06). The odds for SARS-CoV-2 when mostly working outside were similar (OR 0.83, 95% CI 0.80–0.86). The occupation with the highest OR for severe COVID-19 (compared with low-exposure occupations) was certified specialist physician (OR 2.05, 95% CI 1.31–3.21) among women and bus and tram drivers (OR 2.04, 95% CI 1.49–2.79) among men. CONCLUSIONS: Contact with infected patients, close proximity and crowded workplaces increase the risks for severe COVID-19 and SARS-CoV-2 infection. Outdoor work is associated with decreased odds for SARS-CoV-2 infection and severe COVID-19.

This study aimed to investigate the effects of various aspects of night and shift work regarding incident cerebrovascular disease (CeVD). The cohort included 26 667 women and 3793 men (nurses and nursing assistants) who were employed for at least one year 2008-2016 in Region Stockholm, Sweden. Information about the cohort and working hours were obtained from a computerized employee-register and diagnoses were retrieved from national and regional registers. We used discrete time proportional hazard models to assess the risk of CeVD (2009-2017), in relation to work hour characteristics, adjusting for sex, age, country of birth, education and profession. We observed an excess risk of CeVD (N=223) among employees who, during the preceding year, worked night shifts >30 times [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.04-1.99] or ≥3 consecutive night shifts >15 times (HR 1.69, 95% CI 1.18-2.42) or with >30 quick returns (<28 hours) from night shifts (HR 1.52, 95% CI 1.10-2.10) compared to those who did not work nights. We also observed an excess risk among employees with a long duration (>5 years) of exposure to night shift work (HR 1.87, 95% CI 1.27-2.77), all supported by a dose-response pattern. Our results show that the risk of CeVD among nurses and nursing assistants is associated with night shift work. The number of years with night shift work, the frequency of night shifts per year, the frequency of consecutive night shifts, and short recovery after night shifts influenced the risk. Work schedules aiming at minimizing these aspects of night shift work may reduce the risk.

The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: (a) PE will increase, (b) workers in PE will become more precarious, (c) workers in PE will face unemployment without being officially laid off, (d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and (e) PE might be a factor in deterring the control of or in generating new COVID-19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis.

Many women of childbearing age are occupationally active, which leads to a large number of pregnancies potentially exposed to occupational exposures. Occupational noise has been identified as a risk factor for hearing impairment in adults. However, very few studies have assessed the effect of occupational noise on the fetus. The aim of this study was to investigate whether occupational exposure to noise during pregnancy is associated with hearing dysfunction in children. This population based cohort study included 1,422,333 single births in Sweden 1986-2008. Data on mothers' occupation, smoking habits, age, ethnicity, body mass index, leave of absence, and socioeconomic factors were obtained from interviews performed by prenatal care unit staff at approximately 10 weeks of gestation and from national registers. Occupational noise exposure was classified by a job-exposure-matrix as < 75, 75-84, or ≥ 85 dBLAeq,8h. Diagnosed cases of hearing dysfunction (ICD-10 codes H90.3-7, 91.0, 91.2-3, 91.8, 93.1-2) were identified from a register of specialized medical care. Cox proportional hazards models were used to estimate associations. In the full sample, containing a mixture of part-time and full-time workers during pregnancy, the adjusted HR for hearing dysfunction associated with maternal occupational noise exposure ≥ 85 vs. < 75 dBLAeq,8h was 1.27 (95% CI: 0.99, 1.64; 60 exposed cases). When restricted to children whose mothers worked full-time and had < 20 days leave of absence during pregnancy, the corresponding HR was 1.82 (95% CI: 1.08, 3.08; 14 exposed cases). This study showed an association between occupational noise exposure during pregnancy and hearing dysfunction in children. In view of mechanistic evidence and earlier indicative epidemiological and experimental findings, the results support that pregnant women should not be exposed to high levels of noise at work. Selander J, Albin M, Rosenhall U, Rylander L, Lewné M, Gustavsson P. 2016. Maternal occupational exposure to noise during pregnancy and hearing dysfunction in children: a nationwide prospective cohort study in Sweden. Environ Health Perspect 124:855-860; http://dx.doi.org/10.1289/ehp.1509874.

OBJECTIVES: This study aimed to evaluate effects of night and shift work patterns on type 2 diabetes (T2D) and hypertension in a longitudinal study, with detailed information on working hours. METHODS: The cohort comprised about 28 000 nurses and nursing assistants employed for more than one year 2008–2016 in Stockholm, Sweden. The employee register held detailed individual information on daily working hours. Information on diagnoses came from national and regional registers. Hazard ratios (HR) and confidence intervals (CI) were estimated by discrete-time proportional hazard models, adjusting for sex, age, country of birth, and profession. RESULTS: During follow-up in 2013–2017, we identified 232 cases of T2D and 875 of hypertension. We observed an increased risk of T2D, but not hypertension, among employees who worked only night shifts the previous year (HR 1.59, 95% CI 1.02–2.43) and those with intensive shift work (>120 afternoon and/or night shifts the previous year: HR 1.67, 95% CI 1.11–2.48) compared to only day work. There was a non-significantly increased risk of T2D related to mixed day and afternoon shifts (HR 1.34, 95% CI 0.97–1.88). We observed tendencies in increased risk of T2D related to frequent spells of ≥3 consecutive night shifts and with number of years with exclusive (but not mixed) night work. CONCLUSIONS: Permanent night work and frequent afternoon and/or night shifts were associated with an increased risk of T2D the following year, but not hypertension. The T2D risk was, to some extent, affected by frequent spells of several night shifts in a row and by cumulative years with permanent night work.

Childhood cancer aetiology is poorly understood and is considered to originate in utero and early postnatal life. In this study, we investigated perinatal characteristics as potential risk factors by performing a population-based case-control study, including 1340 cancer cases diagnosed < 19y and born between 1989–2021 in southern Sweden, and 13400 controls matched by sex, year, and municipality of birth. Perinatal characteristics were obtained from seven national registries. Cox regression was used to examine the associations between perinatal characteristics and the risk of overall childhood cancer, leukaemia, CNS tumours, lymphoma, and other cancer types combined (OCT). Large for gestational age was associated with a higher risk of overall cancer (HR, 95%CI: 1.32, 1.02–1.69) and leukaemia (HR, 95%CI: 1.58, 1.01–2.5), while a 5-min Apgar score <7 indicated a higher risk of OCT (HR, 95%CI: 2.16, 1.12–4.15). Mechanical ventilation during neonatal care was associated with a higher risk of overall cancer (HR, 95%CI: 1.88, 1.39–2.53) and OCT (HR, 95%CI: 2.09, 1.19–3.39). The aforementioned characteristics were associated with up to a threefold increased risk among children diagnosed before six months of age compared to those diagnosed later. Additionally, maternal obesity was associated with a higher risk of CNS tumours (HR, 95%CI: 1.51, 1.04–2.21) and lymphoma (HR, 95%CI: 2.26, 1.31–3.88), and maternal underweight with a higher risk of leukaemia (HR, 95%CI: 2.43, 1.40–4.22). Planned caesarean delivery indicated an increased risk of OCT (HR, 95%CI: 1.52, 1.04–2.22). Our findings identify several perinatal characteristics associated with childhood cancer risk, highlighting the perinatal period as an important window for future etiological research.